Milwaukee Journal Sentinel

MILWAUKEE – Do you feel it in your bones that sunny autumn days are in the distant past and that the long gray winter has begun?

Did you feel a major blow when daylight-saving time ended and made it impossible to leave work before dark?

Many feel the effect of the change of seasons as early as August or September.

They dread the shorter days and coming winter – they eat more, sleep more and suffer from a form of depression called seasonal affective disorder, or SAD.

Traditional approaches to treat the disorder include using anti-depressant drugs or light therapy, or a combination.

New research indicates that adding cognitive behavior therapy, or “talk therapy,” to the mix might be more effective treatment.

The disorder has likely existed for centuries but was not given a name until the 1970s when the National Institutes of Health asked if people noticed they were eating and sleeping more in the winter.

Researchers were flooded with calls.

The symptoms of SAD go way beyond the winter blues and subtle changes in eating and sleeping. It can include cravings for sweets and starches, fatigue, irritability, social withdrawal and depression. These changes disappear in the spring and summer.

Peter Lundberg, 48, has had symptoms associated with SAD for 30 years. Take his bedtime: In the summer, he usually goes to bed about 11 p.m.; this time of year, he’s ready for bed at 8:30.

Shorter days seem to trigger symptoms.

There is some evidence that light intensity and temperature also may play a role, said Kelly Rohan, an assistant professor of psychology who studies SAD at the University of Vermont.

There are many theories about SAD, said Carlyle Chan, a professor of psychiatry and behavioral medicine at the Medical College of Wisconsin.

In the winter, the production of melatonin – a sleep hormone related to depression – may increase.

The lack of sunlight is thought to decrease the amount of serotonin, which is a brain chemical triggered by sunlight.

Sunlight patterns are also known to affect the activities of animals and may shift internal biological clocks, or circadian rhythms, in people, causing daily schedules to be out of sync with biological clocks.

The depression that comes with SAD can vary. Generally it tends to be in the mild and moderate range, said Michael Young, an associate professor of psychology at the Illinois Institute of Technology in Chicago.

The percentage of people with SAD generally increases with increasing latitude.

“At this latitude, 7 percent to 9 percent of the population has changes that significantly impact their everyday functioning,” Young said.

There are several different ways to treat SAD. Young believes light therapy should be the first approach.

When Chan sees patients with seasonal depression he recommends light therapy but believes some people may respond better when the therapy is combined with medication.

Sara Brandt, 34, was diagnosed with SAD about five years ago and was initially given anti-depressants. After cycling through about 15 to 20 medications, she learned about light therapy and discussed it with her doctor.

Every morning for 30 minutes Brandt uses a light box with a light intensity of 10,000 lux, and she feels that it helps.

By comparison, indoor lighting can range from 100 to 1,000 lux, and a bright sunny day can be as high 50,000 lux.

Rohan’s research involves cognitive behavioral therapy, which is an effective treatment for depression. She wondered if the therapy could be an effective means to treat SAD.

Behavioral therapy is a form of psychotherapy in which therapists work with patients to overcome problems by changing their thinking, behavior and emotional responses.

The components of the therapy for treating SAD are the same as for depression, with the addition of the environmental factor, said Rohan.

“It is a way to cope with fall and winter and the negative thoughts about winter and what they mean,” she said.

She said the challenge is that patients often have outdoor interests and depend on summer. Patients need to look for winter activities.

In her study, Rohan randomly assigned 61 SAD patients to four groups for six weeks of treatment: daily light therapy; 12 sessions of behavioral therapy; a combination of both treatments; or wait-list control group.

All groups – even the control group, which received treatment after waiting six weeks – showed comparable improvement in their depression and SAD symptoms after six weeks of treatment. Of the patients treated with light and talk therapy, 80 percent were no longer depressed and of the patients treated with light therapy alone, 53 percent were no longer depressed.

During winter of the following year, patients who had been treated with talk therapy – both alone and in combination with light therapy – were less depressed than those treated with light therapy alone. Six percent of the cognitive behavior therapy patients met the criteria for depression while 40 percent of the patients treated with light therapy alone met the criteria.

Rohan said at the one-year follow-up, study participants treated with the light therapy box don’t keep using their light box. She believes that patients treated with talk therapy keep using the skills learned during their treatment.

The study’s results were presented at the annual meeting of the American Psychiatric Association in Atlanta last May and at this month’s annual meeting of the Association for Behavioral and Cognitive Therapies in Washington, D.C. The results of a previous study are published in the June issue of the Journal of Affective Disorders.

Rohan now plans a randomized clinical trial with a larger sample size that compares light therapy with talk therapy and focuses on one-year outcomes.